氯吡格雷对胃肠道的损害及其防治

Impact of proton pump inhibitors on clinical outcomes in patients receiving clopidogrel and possible mechanisms

Clopidogrel, a second generation thienopyridine antiplatelet agent, is increasingly prescribed for patients with recent stroke, myocardial infarction, acute coronary syndrome, or those undergoing percutaneous coronary intervention. Current consensus recommends co-administration of proton pump inhibitors (PPIs) during clopidogrel therapy to reduce the risk of gastrointestinal complications. However, studies have demonstrated a significant reduction in platelet inhibition when PPIs therapy is administered to subjects on clopidogrel, which thus increases the risk of adverse cardiovascular events. There have been recent concerns about the safety of PPIs though the postulated link between PPI use and adverse cardiovascular events has not been well established since evidence from randomized controlled trials does not support such an association. Here, we review the impact of PPIs on clinical outcomes in patients on clopidogrel and the possible mechanisms.

Clopidogrel suppresses the proliferation of human gastric epithelial GES-1 cells

AIM: To investigate the effects of clopidogrel on the proliferation of human gastric epithelial GES-1 cells.

METHODS: GES-1 cells were cultured in vitro. After GES-1 cells were incubated with clopidogrel at concentrations of 0.01, 0.1, 0.5 and 1 mmol/L for 24, 48 and 72 h, the reduced proliferation rates of GES-1 cells were examined using methyl thiazolyl tetrazolium (MTT) assay. A dose-response curve was established by plotting the reduced cell proliferation rates against the concentrations of clopidogrel. The half maximal inhibitory concentration (IC₅₀₎ and safe concentration (IC₉₀, concentration that achieves 90% inhibition) of clopidogrel were calculated using the Bliss method. The morphology changes of GES-1 cells treated with clopidogrel were observed under an inverted phase contrast microscope. Flow cytometry was used to detect cell apoptosis after GES-1 cells were incubated with clopidogrel for 24 h.

RESULTS: Clopidogrel induced GES-1 cell injury in a concentration-dependent manner (F = 11.546, P = 0.002), but not in an obvious time-dependent manner (F = 13.455, P = 0.003). The IC50 and IC90 of clopidogrel at 24, 48 and 72 h were 0.36 and 0.51, 0.35 and 0.08, and 0.16 and 0.08 mmol/L, respectively. After clopidogrel treatment, the number of adherent cells was reduced, cells became round and suspended, and some cells showed nuclear condensation. Flow cytometry analysis indicated that the apoptosis rates of cells treated with clopidogrel at concentrations of 0, 0.01, 0.1, 0.5 and 1 mmol/L were 4.7%, 5.3%, 14.7%, 51.0% and 60.5%, respectively. The apoptosis rate of GES-1 cells rose with the increase in drug concentration.

CONCLUSION: Clopidogrel can inhibit the proliferation and induce the apoptosis of GES-1 cells in a concentration-dependent manner.

Advances in clinical research on the interaction between proton pump inhibitors and clopidogrel

As a new antiplatelet drug, clopidogrel is the cornerstone of drug treatment for coronary artery disease. However, clinical use of clopidogrel frequently leads to gastrointestinal injury or increases the risk of gastrointestinal bleeding. To prevent clopidogrel-associated gastrointestinal injury, concomitant proton pump inhibitors (PPIs) have been used widely in clinical practice. However, recent studies show that treatment with clopidogrel plus PPIs can increase the incidence of adverse cardiovascular events. Despite being controversial, this finding has attracted wide attention from clinicians. This article will review the recent advances in clinical research on the interaction between proton pump inhibitors and clopidogrel.